Section A. This paper opens with a broad overview of theoretical and empirical literature on refugee mental health. It highlights a relative weakness in the understandings of post-migration mental health, particularly in the context of female refugees. The paper then focuses on three areas of refugee women's mental health, critically evaluating theoretical and empirical literature: 1) risk factors and prevalence of mental health difficulties 2) coping strategies, 3) mental health service utilisation. Gaps in the extant literature are highlighted and suggestions are made for future research. Section B. This paper describes a qualitative study which aimed to explore refugee women's experiences of distress and their encounters with mental health services in the UK. Refugee women do not utilise UK mental health services as frequently as might be expected owing to their vulnerability to mental health problems. The study investigated the mental health experiences of refugee women who have encountered mental health services in the UK in order to contribute to understandings about factors affecting service utilisation. A grounded theory qualitative methodology was employed. Ten refugee women were recruited from a local non-governmental organisation and participated in semi-structured interviews about their experiences of distress, coping strategies and encounters with UK mental health services. A two-staged model emerged from the data. The first model depicted women’s experiences of distress predominantly in the context of post-migration experiences and how they coped, drawing notably from spiritual and social resources. The second stage of the model indicated how mental health service encounters were varied and a process of engagement involved evaluation and re-evaluation at particular stages. The study concluded that understanding refugee women’s utilisation of mental health services demands a multi-factorial, dynamic appraisal. Section C. This paper offers a critical appraisal of the study reported in Section B. The paper reflects on the research skills and abilities developed by the principal researcher and considers areas for development in terms of future clinical and research work in this field.

Section A consists of a literature review which explores the concept of recovery and its relevance for women who have been detained in a secure setting and diagnosed with a personality disorder. Section B presents the findings of a study to explore the concept of recovery in women diagnosed with personality disorder in a secure unit. Six semi- structured interviews, conducted with women diagnosed with personality disorder and experience of being detained in secure accommodation, were analysed using Interpretative Phenomenological Analysis. Analysis of the transcripts revealed five master themes: recovering; centrality of relationships; assuming responsibility for own care; evolving an identity; understanding of the mental health experience. The study concludes that, as far as is consistent with a secure setting, women should be given maximum opportunity to participate in decisions about their own care. Staff should be creative in providing opportunities for the women to engage in meaningful activities that promote a positive identity. Education with respect to personal recovery and the presentation and aetiology of personality disorder may support more caring and hopeful relationships between staff and service users, within which recovery can be facilitated. Section C involves a critical appraisal of the study.

Despite the profession’s putative reflexivity, little theoretical or empirical literature addresses British clinical psychologists’ beliefs about the nature of their profession and its relationship with the wider mental health system. This study examined attitudes towards one new development – the adoption of compulsory powers – in order to discover the implicit beliefs that clinical psychologists draw upon in practice. Written comments from 292 clinical psychologists responding to an earlier questionnaire survey were analysed using Grounded Theory, together with data from a focus group. Two contrasting constellations of belief emerged. Some clinical psychologists appeared to believe in the profession’s ability to transform services from the inside by opportunistically accreting power. Others appeared to believe in a need to defend the profession against assimilation, by maintaining separate spaces for more collaborative relationships. These overarching beliefs were associated with different beliefs about specific issues, namely professional identity, its compatibility or otherwise with coercion, where power is located and what drives organisational change. These findings suggest a need for greater professional self-examination. They are considered with reference to organisational, sociological and psychological literature. Limitations and areas for further research are discussed.

Section A is a review of the literature on the psychological and social implications of cochlear implants (CIs) in deaf children and adolescents. The literature is critically evaluated in relation to health-related quality of life, quality of life, psychological and emotional well-being, social well-being and identity. Relevant theories are outlined and discussed. Methodological limitations and gaps in the literature are discussed, and the review concludes with recommendations for further research. Section B describes a study using Interpretative Phenomenological Analysis to explore adolescent experiences of receiving and living with sequential cochlear implants (SCIs). Semi-structured interviews were conducted with eleven adolescents. The master and sub-themes are presented and the results are discussed with consideration of previous research findings and theoretical, clinical and research implications. Most participants enjoyed improved confidence and social well-being following their SCI, and felt that two CIs were superior to one. The majority identified themselves as hearing and deaf, but not culturally Deaf, as they strived to live in the hearing world. However, this was not without challenges and many young people experienced feelings of difference in the hearing world. These findings have clinical implications in terms of the role of clinical psychologists in CI clinics, and in providing information to families making decisions about CIs. These findings add to the emergent deaf identity development literature in young people with CIs.

Service user involvement (SUI) in healthcare and education is an established element of government policy. Emerging research demonstrates that SUI in education can positively impact on mental health students' learning. However, limited empirical attention has been paid to the impact on practice in this area. Moreover, no research has investigated whether impact on practice is sustained. Section B describes a qualitative study exploring qualified clinical psychologists' (CPs) experiences of a placement-based service user and carer involvement (SUCI) scheme during their training. The study focused on understanding their perception of the scheme's impact on their learning and practice and whether the impact on practice was sustained. Seven CPs were interviewed, predominantly 32-33 months post-scheme. Interpretative Phenomenological Analysis was used to analyse the data. Four super-ordinate themes were identified: “Contextual and relational factors underpinning learning”; “Learning: Personal and professional development”; “The enduring impact on practice”; and “Personal reflections and meaning-making”. The findings are discussed in relation to existing literature and relevant theory, including adult learning theories and social positioning theory. The findings suggest that SUCI in placement-based learning during training can support CPs' personal and professional development and a partnership approach to practice. Two participants' experiences highlight factors raising questions regarding for whom and when SUCI may be beneficial to learning. Methodological limitations, implications for SUCI in clinical psychology training and directions for future research are presented.

Section A is a literature review, exploring the psychological theories behind gardening-based mental health interventions and providing an overview of the current evidence to support their use. It builds on the last comprehensive review conducted in 2003, finding that the evidence-base has developed considerably over the past decade but that there is still a need for higher quality research in this field. Section B considers the value of gardening in promoting wellbeing in a non-clinical sample. A qualitative study is presented in which six suburban allotment-holders completed in-depth interviews about their allotment gardening and its perceived impact on their wellbeing. Transcripts were subjected to Interpretative Phenomenological Analysis (IPA). Seven main themes emerged from the data: fundamental importance of food, protection and safety, feeling connected, esteem, pleasure of being in nature, development and values. Parallels were drawn between these themes and Maslow’s hierarchy of needs. While each participant talked to some extent about all of the themes, a different theme was dominant for each individual, suggesting that allotments are flexible environments that may enable people to meet their individual needs, in order to enhance wellbeing. Implications for clinical and community psychology are discussed.

The importance of early intervention for positive outcomes following a first episode of psychosis (FEP) is recognised, however, there are still delays in young people seeking help. The aim of this qualitative study was to explore beliefs about help-seeking in young people who have recently experienced a FEP. Twelve participants were interviewed and transcripts were analysed using grounded theory. Five categories of beliefs were identified which contributed to the development of a preliminary model of beliefs about a need for help-seeking. Young people’s beliefs about their experiences as normal or abnormal, and about the process and outcome of help-seeking, influenced beliefs about needing help. Existing beliefs about mental health problems, and beliefs about the impact of experiences on the self were important to the meaning young people ascribed to beliefs about help-seeking. Social networks were important in the development of these beliefs. The study identified beliefs which promoted and inhibited young people’s help-seeking beliefs for FEP. Self-stigma was present prior to help-seeking. Implications for clinical interventions include education to promote help-seeking for distress and not abnormality, and to dispel myths about the help-seeking process and outcome. Further research is needed to determine which beliefs are most important to young people’s help-seeking for FEP.

Section A is a review of literature which has explored the experience of dementia in the context of couple relationships. Four key themes thought to be central to this experience were identified and highlight the impact of dementia upon couple relationships, and how aspects of relationships may influence the experience of dementia. Limitations and gaps in our understanding are highlighted. Most significantly, the existent literature focuses upon care partners’ perceptions and excludes people with dementia. Therefore, it is argued that a relational understanding of the experience of dementia, in the context of couple relationships, remains unknown. The review concludes with a rationale for why further research is needed and how people with dementia could be included. Section B describes a qualitative study, using interpretative phenomenological analysis, to investigate couples’ experiences of dementia. Seven couples were interviewed and five master themes (‘foundations’, ‘altered structures’, ‘self-restoration’, ‘flexible scaffolding’ and ‘reflective capacity’) emerged from analysis of the data. These themes offer an understanding of the experience of dementia from a relational perspective and depict the ways in which couples construct their experience in order to make sense of dementia, and the processes that they adopt in order to adjust to dementia. The findings of this study are supported by existing empirical and theoretical literature and have implications for future research and clinical practice.

Section A presents a literature review which aims to consolidate the theoretical and empirical psychological research regarding refugees’ post-migration, to clarify and further understand their psychological experiences and needs. The literature search yielded papers which are divided into four sections: refugees and post traumatic stress disorder (PTSD); refugees, complicated grief and cultural bereavement; refugees, resettlement and acculturation; and refugees and Quality of Life (QoL). The review highlights key findings and areas requiring further exploration. Section B reports an exploratory narrative study which aims to explore the role of QoL in the narratives of refugees with a diagnosis of PTSD. Episodic semi-structured interviews were conducted with seven refugees (5 males, 2 females), and analysed using narrative thematic, structural and performance analysis. The results illustrated containing and consistent support was important in progressing the transition from suffering during asylum-seeking to a refugee with hope, and improved QoL and psychological health. The results are applied to theory and research, and limitations of the study are discussed.

It has been suggested that professionals working with trauma survivors can experience positive change and growth, but there is a dearth of research evidence. Therefore this study aimed to develop a preliminary model, grounded in data, encapsulating the processes and outcomes involved in positive change in a sample of these professionals. Twelve professionals (clinical psychologists, psychotherapists, a psychiatrist, and a solicitor) with experience of working with trauma survivors were interviewed about their experiences of positive change in relation to their work. Semi-structured interviews were audio taped, transcribed and analysed using a grounded theory approach. A model was developed for an episode of positive change, based upon four main processes that seemed to follow on from each other: key experiences in the work, emotional disruption, coping, and enduring positive changes. Conditions that influenced the intensity of emotional disruption experienced by professionals were also identified. The model of enduring positive change provides a fuller account of the growth processes and outcomes than previous literature to date. The main implication is that experiencing an emotional disruption as a consequence of the work can be a normal reaction to the work, and it may eventually lead to enduring positive change. This has further implications for training, supervision and continued professional development.